Provider Demographics
NPI:1821045733
Name:HENSEL, STEVEN ROLLAND (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ROLLAND
Last Name:HENSEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 N BARLOW RD
Mailing Address - Street 2:P.O. BOX 220
Mailing Address - City:LINCOLN
Mailing Address - State:MI
Mailing Address - Zip Code:48742
Mailing Address - Country:US
Mailing Address - Phone:989-736-8422
Mailing Address - Fax:989-736-8749
Practice Address - Street 1:324 N BARLOW RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:MI
Practice Address - Zip Code:48742
Practice Address - Country:US
Practice Address - Phone:989-736-8422
Practice Address - Fax:989-736-8749
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID118171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4063850Medicaid
MI4067071Medicaid